What to Expect with Uterine Fibroids

Uterine fibroids can cause life-altering symptoms, and many women don’t realize they have fibroids until these symptoms become so bad they impact their ability to participate in normal activities. When a patient consults our specialists, we aim to provide the least invasive treatment option available, Uterine Fibroid Embolization (UFE), to provide relief from symptoms without surgery, a lengthy recovery, or a costly procedure. In this interview, Melissa Vignona, FNP-BC explains what to expect with uterine fibroids and uterine fibroid embolization.

What Should a Patient Expect from a UFE Consult?

When a patient initially comes in for a consultation, we’re looking for a medical history, a surgical history, allergies, and medication reconciliation. The most important thing is learning what the woman has been going through with her periods, bleeding issues, any pain associated with her cycle, urinary frequency, and constipation. We ask all of these questions to find out if the symptoms are, in fact, due to uterine fibroids.

Typically, an ultrasound is used for the diagnosis of uterine fibroids. Often, the patient already has had prior testing, and they’ve been referred by their GYN. They already know that they have fibroids and have come to us to discuss their options. Then there are times when they have found us on social media, and they say, “I know that this is what I have. My mother had a hysterectomy. My aunt has fibroids. I just know that it’s something that I’ve been dealing with. I just haven’t officially been diagnosed.” We will send the patient for an ultrasound to determine whether they do have fibroids. That investigation includes an MRI.

We need an MRI in order to find out the size and location of the fibroids. If the patient has already had an ultrasound, we just give them a script for an MRI then we’re able to put the whole story together. That ultrasound is one extra step but if somebody does not have prior testing. Then we take time to explain the procedure and discuss with the patient what’s going to help them. Offering them help to determine whether UFE is right for them is very important. The patient has been going through a lot, and it’s a very emotional process. We’re very supportive in that sense and offer more time for this consultation to make sure they have the time they need to make the right decision for them.

Ensuring that Uterine Fibroid Embolization would be the best option for our patients is something very important to us. After discussion, we determine whether or not they want to move forward with it. We’re then able to provide preoperative instruction, advising what medications to continue and what to stop prior to undergoing the procedure itself. Once we have authorization from the insurance company, we’re able to just move forward, often before the patient’s next period.

If You Have Uterine Fibroids, When Do They Need to be Treated?

Uterine fibroids are only treated when the symptoms start presenting themselves. People can go many years without having any symptoms, though they often know that they have fibroids because they’ve had ultrasounds. Some people have found fibroids through ultrasounds done when they are pregnant. Until the fibroids start causing severe bleeding, pain, urinary frequency, and constipation, and they start getting very large in size, treatment is not necessary. We’ve treated women that feel like they’re four or five months pregnant because of the size of the fibroid itself, which is the compressing of all of their organs. That’s when we would treat it. When there are symptoms impacting the quality of life, we can consider treatment.

How Do You Stop Heavy Bleeding from Fibroids?

Heavy bleeding can be controlled with medications, usually given to you by your OB-GYN prior to visiting us, though that’s a more conservative option. There are also treatments, such as myomectomies, where we remove the actual fibroid. Then there’s a hysterectomy, where the entire uterus is removed. Our preferred option is Uterine Fibroid Embolization. Most of the time, when somebody is suffering from severe bleeding, the fibroid is on the inner wall of the uterus. With UFE, we’re able to target multiple fibroids instead of just taking out one or two with a myomectomy. The biggest benefit to doing this procedure is that if we don’t find that the results are what you were looking for, we have other options. UFE is a very minimally invasive procedure. It takes between 45 minutes to an hour and a half to actually target these fibroids. We inject little particles into the arteries that block the blood flow to them, so the fibroids tend to shrivel up and die off over time.

If you’ve tried UFE and you want to move on with a different option, that is fine. However, if you start with a more invasive, permanent procedure like a hysterectomy, there’s no going back to try something else. UFE is a very helpful, rewarding step that definitely gives patients some great results prior to doing anything surgical because it’s so minimally invasive. Everything’s done through a very small puncture. A lot of times, women ask, “Where did you even go through? I don’t see anything.” We go through a very small artery, either in the groin or the wrist, depending on the doctor, but most of the time, it is the groin. It is a very short procedure and recovery time with us. Typically, it’s just two hours, but can be up to four hours, because we have closure devices in order to seal off that artery that we entered through. It’s an ambulatory procedure. You’re out after a couple of hours with great results, especially when it comes to bleeding.

What Does Fibroid Pain Feel Like During Your Period?

Fibroid pain is absolutely debilitating. Some patients won’t leave their house and they have to work around their schedule when they have their period. I actually went to support a patient for dialysis one time, and his daughter said to me, “Oh, you know what? I really can’t come at this time and bring my father because it’s that time of the month, and I can’t leave my house.” We ended up doing a Uterine Fibroid Embolization on her and she had amazing results. Some people have to put their life on hold, and their quality of life just goes down so far. I’ve heard it described as a stabbing pain, abdominal pain, low back pain, and a dull ache. I’ve seen people who have taken tons of Motrin and Tylenol having to switch between the two in order to get mild or moderate relief. It can be very, very severe.

What are the Different Types of Fibroids?

There are four different types of fibroids, discernable by certain characteristics that present with symptoms. Fibroids on the inside of the uterine wall are called submucosal. These fibroids typically cause tons of bleeding, where women are changing extremely saturated overnight pads or diapers, or pads inside of diapers every four hours, with all kinds of severe bleeding, anemia, blood transfusions, and iron infusions. Then there are intramural fibroids, which are inside the walls of the uterus. These typically have bleeding and pain correlated with them.

Fibroids laying on the outer part of the uterus, typically causing a lot of pain, are called subserosal fibroids. These become pretty large and press up against women’s backs. They cause a lot of sciatica type of back pain. They’re the fibroids that are usually visible through the abdomen. People might feel a hard ball or even pulsation, especially when laying on it, because that blood flow is trying to get to the fibroid itself. Subserosal fibroids are the ones that typically press on the intestines causing constipation issues as well. Then there’s something called a pedunculated fibroid, where the fibroid itself branches off on a stalk, almost like a mushroom. These are important because there may be a slight risk of those breaking off. We need an MRI in order to determine the size and location of the fibroid and assess that risk.

Request a Consultation with American Endovascular

If you are experiencing uterine fibroid symptoms, please request a consultation with one of our affiliated physicians at one of our vascular centers in New York, New Jersey, and Ohio.